Project description:Emergency responses to the COVID-19 pandemic led to major changes in travel behaviours and economic activities in 2020. Machine learning provides a reliable approach for assessing the contribution of these changes to air quality. This study investigates impacts of health protection measures upon air pollution and traffic emissions and estimates health and economic impacts arising from these changes during two national 'lockdown' periods in Oxford, UK. Air quality improvements were most marked during the first lockdown with reductions in observed NO2 concentrations of 38% (SD ± 24.0%) at roadside and 17% (SD ± 5.4%) at urban background locations. Observed changes in PM2.5, PM10 and O3 concentrations were not significant during first or second lockdown. Deweathering and detrending analyses revealed a 22% (SD ± 4.4%) reduction in roadside NO2 and 2% (SD ± 7.1%) at urban background with no significant changes in the second lockdown. Deweathered-detrended PM2.5 and O3 concentration changes were not significant, but PM10 increased in the second lockdown only. City centre traffic volume reduced by 69% and 38% in the first and second lockdown periods. Buses and passenger cars were the major contributors to NO2 emissions, with relative reductions of 56% and 77% respectively during the first lockdown, and less pronounced changes in the second lockdown. While car and bus NO2 emissions decreased during both lockdown periods, the overall contribution from buses increased relative to cars in the second lockdown. Sustained NO2 emissions reduction consistent with the first lockdown could prevent 48 lost life-years among the city population, with economic benefits of up to £2.5 million. Our findings highlight the critical importance of decoupling emissions changes from meteorological influences to avoid overestimation of lockdown impacts and indicate targeted emissions control measures will be the most effective strategy for achieving air quality and public health benefits in this setting.
Project description:Air travelers can carry an infectious disease's pathogenic microorganism in their bodies and spread the disease from one country to another in a few days. To delay the spread, health screening stations may be set up at airport terminals to screen travelers. This research tested three different health screening strategies, each with a different combination of screening stations at trip origins, destinations and connecting airports. Discrete event simulations were performed, based on the 2014 to 2016 Ebola virus epidemic, with special focus on travelers from the West African countries traveling to the United States, including travelers who transferred flights at airports in European Union member states. The effectiveness of the screening strategies was analyzed in terms of correct detection, missed detection and false alarm rate. The results showed that exit screening at trip origins brought big improvements in the performance measurements compared to no screening. However, additional screening at the destinations and connecting airports contributed marginal benefits.
Project description:BackgroundFolate plays an essential role in the prevention of neural tube defects, yet little is known about the folate status of women of reproductive age or to what degree the general population is aware of the importance of folate in early-life development. We aimed to determine folate status in women of reproductive age and pregnant women in Switzerland, and to assess folate awareness in the Swiss population.MethodsIn a convenience sample of 171 women of reproductive age and 177 pregnant women throughout Switzerland, we measured red blood cell (RBC) folate concentration. In a second convenience sample (n = 784, men and women) we assessed folate knowledge with an online survey.ResultsRBC folate concentration (median interquartile range) was 442 (366, 564) nmol/L in women of reproductive age and 873 (677, 1177) nmol/L in pregnant women. Folate deficiency (RBC folate <340 nmol/L) was found in 19.9% of women of reproductive age and 2.8% of pregnant women, while 91.8% of women of reproductive age and 52.0% of pregnant women showed folate concentrations indicating an elevated risk of neural tube defects (RBC folate <906 nmol/L). The online survey showed that a high proportion (?88%) of participants were aware of folate's role in neural tube defect (NTD) prevention and fetal development, yet knowledge about dietary sources and national recommendations of folate supplementation when planning pregnancy were limited.ConclusionThe high prevalence of folate inadequacy in Swiss women suggests an elevated risk of neural tube defects and calls for urgent measures to increase folate intakes.
Project description:RationaleAdolescents and young adults were identified internationally as a group with potentially low compliance rates with public health measures aimed at curbing the spread of coronavirus disease 2019 (COVID-19). Although non-compliance research during pandemics has typically focused on concurrent correlates, less is known about how prior social and psychological risk factors are associated with non-compliance during pandemics.ObjectiveThis paper leverages a prospective-longitudinal cohort study with data before and during the pandemic to describe patterns of non-compliance with COVID- 19 related public health measures in young adults and to identify which characteristics increase the risk of non-compliance.MethodsData came from an ongoing cohort study in Zurich, Switzerland (n=737). Non-compliance with public health measures and concurrent correlates were measured at age 22. Antecedent sociodemographic, social, and psychological factors were measured at ages 15-20. Young adults generally complied with COVID-19 public health measures, although non-compliance with some measures (e.g., cleaning/disinfecting mobile phones, standing 1.5-2 meters apart) was relatively higher.ResultsNon-compliance, especially with hygiene-related measures, was more prevalent in males, and in individuals with higher education, higher SES, and a nonmigrant background. Non-compliance was higher in young adults who had previously scored high on indicators of "antisocial potential," including low acceptance of moral rules, pre-pandemic legal cynicism, low shame/guilt, low self-control, engagement in delinquent behaviors, and association with delinquent peers. Young adults with low trust, including in the government's measures for fighting the virus, also complied less.ConclusionsIn order to increase voluntary compliance with COVID-19 measures, public health campaigns should implement strategies that foster moral obligation and trust in authorities, or leverage trustworthy individuals in the community to disseminate information. For young adults with low self-control, self-monitoring, environmental restructuring, or nudging may increase compliance. Long-term investments into integrating youth with antisocial potential into society may decrease rule-breaking behaviors, including during pandemics when compliance saves lives.
Project description:ContextThe coronavirus pandemic (COVID-19) has caused a major health crisis, requiring the implementation of various public health measures in order to slow the spread of the virus and reduce the associated mortality. However, the success of these measures depends on people's acceptance of them. This research aimed at understanding people's representations of COVID-19 and its crisis management, and ultimately at understanding their attitudes toward health measures for counteracting the spread of COVID-19 in Reunion Island together with the behaviours expected of them.MethodUsing Random Digit Dialling, a qualitative study was conducted with 53 inhabitants between February and May 2021. The COREQ checklist was followed. A dual textometric and manual thematic analysis was adopted in order to identify representations of COVID and the management of the crisis.ResultsSome respondents perceived COVID-19 as a serious disease, while others saw it as a banal virus or even doubted its existence. A perceived ineffectiveness of public health measures and the incompetency of public actors predominated in the participants' discourse.ConclusionsThus, there was a considerable lack of trust and negative attitudes toward health measures, possibly influencing people's acceptance and explaining numerous controversies. This research examines the importance of considering people's representations of the health situation in order to improve people's acceptance of protective measures.
Project description:RationaleAn important public health strategy during the COVID-19 pandemic was the protection of people at risk of severe progressions of an infection; namely, older people and people with pre-existing conditions.ObjectiveTo improve public health communication, it is vital to understand, which sociodemographic and psychological factors drive older people's acceptance of and compliance with public health measures.MethodThis goal was pursued in this three-wave longitudinal online study with older adults, collected between March and June during the COVID-19 pandemic in 2020 (N = 327; first and second wave during the national lockdown; third wave: after the lifting of most lockdown measures).ResultsThe results show that overall acceptance of and adherence to the public health measures were high among older adults and even more so for people with pre-existing conditions (e.g., cancer, type II diabetes). However, some infringements of the measures were observed, and the longitudinal analyses suggest that increases in social trust positively influenced acceptance of measures over time, while trivialising beliefs and health fears impacted older adults' compliance with protective measures over time.ConclusionsThis study offers insights into the behavioural responses of older adults to an ongoing threat and the associated uncertainty that is part of public communication about the pandemic and protective measures.
Project description:Indian cities struggle with some of the highest ambient air pollution levels in the world. While national efforts are building momentum towards concerted action to reduce air pollution, individual cities are taking action on this challenge to protect communities from the many health problems caused by this harmful environmental exposure. In 2017, the city of Ahmedabad launched a regional air pollution monitoring and risk communication project, the Air Information and Response (AIR) Plan. The centerpiece of the plan is an air quality index developed by the Indian Institute of Tropical Meteorology’s System for Air Quality and Weather Forecasting and Research program that summarizes information from 10 new continuous air pollution monitoring stations in the region, each reporting data that can help people avoid harmful exposures and inform policy strategies to achieve cleaner air. This paper focuses on the motivation, development, and implementation of Ahmedabad’s AIR Plan. The project is discussed in terms of its collaborative roots, public health purpose in addressing the grave threat of air pollution (particularly to vulnerable groups), technical aspects in deploying air monitoring technology, and broader goals for the dissemination of an air quality index linked to specific health messages and suggested actions to reduce harmful exposures. The city of Ahmedabad is among the first cities in India where city leaders, state government, and civil society are proactively working together to address the country’s air pollution challenge with a focus on public health. The lessons learned from the development of the AIR Plan serve as a template for other cities aiming to address the heavy burden of air pollution on public health. Effective working relationships are vital since they form the foundation for long-term success and useful knowledge sharing beyond a single city.
Project description:ImportanceThe effectiveness of public health measures implemented to mitigate the spread and impact of SARS-CoV-2 relies heavily on honesty and adherence from the general public.ObjectiveTo examine the frequency of, reasons for, and factors associated with misrepresentation and nonadherence regarding COVID-19 public health measures.Design, setting, and participantsThis survey study recruited a national, nonprobability sample of US adults to participate in an online survey using Qualtrics online panels (participation rate, 1811 of 2260 [80.1%]) from December 8 to 23, 2021. The survey contained screening questions to allow for a targeted sample of one-third who had had COVID-19, one-third who had not had COVID-19 and were vaccinated, and one-third who had not had COVID-19 and were unvaccinated.Main outcomes and measuresThe survey assessed 9 different types of misrepresentation and nonadherence related to COVID-19 public health measures and the reasons underlying such behaviors. Additional questions measured COVID-19-related beliefs and behaviors and demographic characteristics.ResultsThe final sample included 1733 participants. The mean (SD) participant age was 41 (15) years and the sample predominantly identified as female (1143 of 1732 [66.0%]) and non-Hispanic White (1151 of 1733 [66.4%]). Seven hundred twenty-one participants (41.6%) reported misrepresentation and/or nonadherence in at least 1 of the 9 items; telling someone they were with or about to be with in person that they were taking more COVID-19 preventive measures than they actually were (420 of 1726 [24.3%]) and breaking quarantine rules (190 of 845 [22.5%]) were the most common manifestations. The most commonly endorsed reasons included wanting life to feel normal and wanting to exercise personal freedom. All age groups younger than 60 years (eg, odds ratio for those aged 18-29 years, 4.87 [95% CI, 3.27-7.34]) and those who had greater distrust in science (odds ratio, 1.14 [95% CI, 1.05-1.23]) had significantly higher odds of misrepresentation and/or nonadherence for at least 1 of the 9 items.Conclusions and relevanceIn this survey study of US adults, nearly half of participants reported misrepresentation and/or nonadherence regarding public health measures against COVID-19. Future work is needed to examine strategies for communicating the consequences of misrepresentation and nonadherence and to address contributing factors.
Project description:BackgroundPublic support of public health measures including physical distancing, masking, staying home while sick, avoiding crowded indoor spaces and contact tracing/exposure notification applications remains critical for reducing spread of COVID-19. The aim of our work was to understand current behaviours and attitudes towards public health measures as well as barriers individuals face in following public health measures. We also sought to identify attitudes persons have regarding a COVID-19 vaccine and reasons why they may not accept a vaccine.MethodsA cross-sectional online survey was conducted in August 2020, in Alberta, Canada in persons 18 years and older. This survey evaluated current behaviours, barriers and attitudes towards public health measures and a COVID-19 vaccine. Cluster analysis was used to identify key patterns that summarize data variations among observations.ResultsOf the 60 total respondents, the majority of persons were always or often physically distancing (73%), masking (65%) and staying home while sick (67%). Bars/pubs/lounges or nightclubs were visited rarely or never by 63% of respondents. Persons identified staying home while sick to provide the highest benefit (83%) in reducing spread of COVID-19. There were a large proportion of persons who had not downloaded or used a contact tracing/exposure notification app (77%) and who would not receive a COVID-19 vaccine when available (20%) or were unsure (12%). Reporting health authorities as most trusted sources of health information was associated with greater percentage of potential uptake of vaccine but not related to contact tracing app download and use. Individuals with lower concern of getting and spreading COVID-19 showed the least uptake of public health measures except for avoiding public places such as bars. Lower concern regarding COVID-19 was also associated with more negative responses to taking a potential COVID-19 vaccine.ConclusionThese results suggest informational frames and themes focusing on individual risks, highlighting concern for COVID-19 and targeting improving trust for health authorities may be most effective in increasing public health measures. With the ultimate goal of preventing spread of COVID-19, understanding persons' attitudes towards both public health measures and a COVID-19 vaccine remains critical to addressing barriers and implementing targeted interventions and messaging to improve uptake.
Project description:BackgroundThe provision of highly active antiretroviral therapy (HAART) in resource-limited settings follows a public health approach, which is characterised by a limited number of regimens and the standardisation of clinical and laboratory monitoring. In industrialized countries doctors prescribe from the full range of available antiretroviral drugs, supported by resistance testing and frequent laboratory monitoring. We compared virologic response, changes to first-line regimens, and mortality in HIV-infected patients starting HAART in South Africa and Switzerland.Methods and findingsWe analysed data from the Swiss HIV Cohort Study and two HAART programmes in townships of Cape Town, South Africa. We included treatment-naïve patients aged 16 y or older who had started treatment with at least three drugs since 2001, and excluded intravenous drug users. Data from a total of 2,348 patients from South Africa and 1,016 patients from the Swiss HIV Cohort Study were analysed. Median baseline CD4+ T cell counts were 80 cells/mul in South Africa and 204 cells/mul in Switzerland. In South Africa, patients started with one of four first-line regimens, which was subsequently changed in 514 patients (22%). In Switzerland, 36 first-line regimens were used initially, and these were changed in 539 patients (53%). In most patients HIV-1 RNA was suppressed to 500 copies/ml or less within one year: 96% (95% confidence interval [CI] 95%-97%) in South Africa and 96% (94%-97%) in Switzerland, and 26% (22%-29%) and 27% (24%-31%), respectively, developed viral rebound within two years. Mortality was higher in South Africa than in Switzerland during the first months of HAART: adjusted hazard ratios were 5.90 (95% CI 1.81-19.2) during months 1-3 and 1.77 (0.90-3.50) during months 4-24.ConclusionsCompared to the highly individualised approach in Switzerland, programmatic HAART in South Africa resulted in similar virologic outcomes, with relatively few changes to initial regimens. Further innovation and resources are required in South Africa to both achieve more timely access to HAART and improve the prognosis of patients who start HAART with advanced disease.